1528933124 NPI number — MARY ELIZABETH NORRIS LDO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528933124 NPI number — MARY ELIZABETH NORRIS LDO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORRIS
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LDO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORRIS
Provider Other First Name:
MARY BETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LDO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528933124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 MAINLINE STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-6825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-605-4621
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5826 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-405-2888
Provider Business Practice Location Address Fax Number:
919-405-2889
Provider Enumeration Date:
10/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  1813 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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